聚桂醇硬化疗法与腹腔镜减压术治疗儿童单纯性肾囊肿的疗效比较  

Comparison of ultrasound-guided percutaneous polidocanol sclerotherapy versus laparoscopic deroofing for simple renal cysts in children

作　　者：周广伦[1] 尹鉴淳[1] 孙俊杰 刘晓东[1] 杨志林[1] 李守林[1] Zhou Guanglun;Yin Jianchun;Sun Junjie;Liu Xiaodong;Yang Zhilin;Li Shoulin(Department of Urology,Municipal Children's Hospital,Shenzhen 518034,China)

机构地区：[1]深圳市儿童医院泌尿外科,深圳518034

出　　处：《中华小儿外科杂志》2023年第3期219-223,共5页Chinese Journal of Pediatric Surgery

基　　金：深圳市医学重点学科(SZXK035)。

摘　　要：目的比较超声引导下聚桂醇硬化疗法和腹腔镜去顶减压术治疗儿童单纯肾囊肿的有效性和安全性。方法总结分析2013年5月至2020年4月深圳市儿童医院经超声和CT尿路成像诊断单纯性肾囊肿(囊肿直径>4 cm或囊肿伴有症状者)且接受超声引导下聚桂醇硬化治疗或腹腔镜去顶减压术的48例患儿的临床资料,记录其临床表现、检查结果、手术细节和随访等资料。根据既往手术方法,将研究对象分为聚桂醇治疗组(21例)和腹腔镜去顶减压组(27例),对比两种干预方法的术后不良反应及长期疗效。在治疗后的第1、6、12个月及每年复查1次,通过最后复诊时超声测量囊肿体积与治疗前囊肿体积的比较来评估治疗效果。采用t检验或χ^(2)检验进行组间差异的两两比较。结果单纯性肾囊肿引起的症状以腰腹部疼痛与包块为主。聚桂醇治疗组的手术时间、术后住院时间和住院费用均少于腹腔镜去顶减压组,(36.1±8.5)min比(94.7±17.2)min、(29.2±12.3)h比(81.9±12.8)h、(8193.8±1305.4)元比(13905.7±2089.9)元,差异均有统计学意义(P<0.001)。聚桂醇治疗组术后无感染病例,随访发现1例治疗失败再行腹腔镜去顶减压术。聚桂醇治疗组平均随访时间40.2个月,有效率为95.2%(20/21);腹腔镜去顶减压组平均随访时间38个月,有效率达100.0%(27/27);聚桂醇治疗组与腹腔镜去顶减压组的治疗疗效差异无统计学意义(P=0.493)。结论聚桂醇硬化疗法推荐作为儿童单纯性肾囊肿的首选治疗方法,对于硬化治疗失败者可选用腹腔镜去顶减压术。Objective To compare the efficacy and safety of ultrasound-guided percutaneous polidocanol sclerotherapy versus laparoscopic deroofing for simple renal cysts in children.Methods Between May 2013 and April 2020,48 children with simple renal cysts(cyst size>4 cm or symptomatic)underwent ultrasonography-guided percutaneous polidocanol sclerotherapy or laparoscopic deroofing.Clinical manifestations,examination results,intraoperative findings and follow-up data were recorded.They were assigned into two groups of polidocanol sclerotherapy(n=21)and laparoscopic deroofing(n=27).Long-term efficacies of two groups were compared.Follow-ups were conducted at 1,6,and 12 months and annually thereafter.The efficacy of treatment was assessed by ultrasonic comparison of residual cyst volume with pre-treatment cyst volume.Student's t or Chi-square test was utilized for comparing the inter-group differences.Results Loin/abdominal pain and flank mass were the most common symptoms.Operative duration,postoperative hospital stay and expense of polidocanol sclerotherapy group were significantly less than those of laparoscopic deroofing group[(36.1±8.5)vs(94.7±17.2)min,(29.2±12.3)vs(81.9±12.8)h,(8193.8±1305.4)vs(13905.7±2089.9)RMB](P<0.001).In polidocanol sclerotherapy group,none had infection after treatment,one child underwent laparoscopic deroofing after failed clerotherapy.The average follow-up period was 40.2 vs 38 months with an effective rate of 95.2%(20/21)vs 100%(n=27).Curative effect showed no significant inter-group difference(P=0.493).Conclusions Polycanol sclerotherapy is recommend as a first choice.And laparoscopic deroofing may be reserved subsequently for children with failed sclerotherapy.

关 键 词：囊肿 肾 儿童 硬化疗法 腹腔镜肾囊肿去顶术 

分 类 号：R726.9[医药卫生—儿科]